FCASPL 256 (New Forms JFS 01683 & 01684)
Family, Children and Adult Services Procedure Letter No. 256
April 7, 2014
TO: Family, Children and Adult Services Manual Holders
FROM: Cynthia C. Dungey, Director
SUBJECT: Implementation of new forms JFS 01683 and JFS 01684

This letter transmits two new forms created as a result of Senate Bill 23, which allows adopted children and their lineal descendant access to the adoption records. The forms will be available March 2014 and will be utilized by the Department of Health. The following is a brief explanation of each of the forms:

  • The JFS 01683, "Birth Parent Name Redaction" enables a birth parent to choose to have their name redacted from the copy of documents in the adoption file that an adopted person or their lineal descendant receives if they decide to request a copy of the record. The form stays in the adoption record on file with the Department of Health. In order to be in effect, the form must be submitted to the Department of Health by 3/19/2015. Pursuant to SB 23, this form will no longer be available beginning March 20, 2015.
  • The JFS 01684, "Contact Preference for the Birth Parent(s) of Adopted Children" enables a birth parent of an adopted child to state their preference regarding any type of contact they would like to have with the adopted person or their lineal descendant. The form allows three options; to be contacted by the adopted person directly, to be contacted through an intermediary, or not to be contacted at all. Once completed this form stays in the adoption record on file with the department of health. If the adopted person or their lineal descendant decides to receive a copy of their file, this information will be provided to them.

INSTRUCTIONS: The following chart identifies the material that should be removed from the Family, Children and Adult Services Manual (FCASM) and the material that should be added.

LOCATIONREMOVE AND FILE AS OBSOLETEINSERT/REPLACE
FORMS JFS   01683 (Rev. 3/2014)
  JFS   01684 (Rev. 3/2014)
PROCEDURE LETTERS FCASPL No. 256